Exhibit I-1 Performance Measures. Numerator (general description only)

Transcription

1 # Priority Type Performance Measure Core Measures (implement 9/1/09) 1 C OE Hospital readmissions within 7, 30 and 90 days postdischarge 2 C OE Percent of Members prescribed redundant or duplicated antipsychotic medication 3 C OE Percent of Members diagnosed with a new episode of major depression, treated with antidepressant medication and maintained on antidepressants for at least 84 days (12 weeks) 4 C OE Improvement in Symptom Severity: Child 5 C OE Improvement in Symptom Severity: Adult 6 C OE Maintaining Independent Living Status for Members with Severe Mental Illness (SMI) Number of Member discharges with an inpatient admission within 7, 30, and 90 days of the discharge, reported cumulatively Number of Members with two concurrent pharmacy claims for an atypical antipsychotic medication for 120 days or more during the study period. The number of Members age 18 and older with an 84-day treatment with antidepressant medication Total number of Member inpatient discharges during the reporting period Number of unduplicated Members with one or more pharmacy claims for an atypical antipsychotic medication during the study period. Number of Members age 18 and older diagnosed with a new episode of major depressive disorder and prescribed an antidepressant medication Calculated by HCPF (CCAR) Calculated by HCPF (CCAR) Calculated by HCPF (CCAR) Calculated by HCPF (CCAR) Calculated by HCPF (CCAR) Calculated by HCPF(CCAR) Yes* (if funding available) Page 1 of 16

2 # Priority Type Performance Measure Core Measures (implement 9/1/09) 7 C OE Progress toward Independent Living for Members with Severe Mental Illness (SMI) 8 C AC Penetration Rates by HEDIS Age Groups 9 C AC Overall Penetration Rates by Medicaid eligibility category 10 C AC Overall Penetration Rates by Race category 11 C AC Penetration Rates by Service Category Calculated by HCPF (CCAR) Calculated by HCPF (CCAR) Calculated by HCPF Calculated by HCPF Yes* Calculated by HCPF Calculated by HCPF Yes* Calculated by HCPF Calculated by HCPF Calculated by HCPF Calculated by HCPF 12 C AC Utilization rates by Inpatient, Intensive Outpatient or Partial Hospitalization, and ED Number of Members with (a) at least one discharge from a hospital episode for treatment of a covered mental health diagnosis, (b) at least one Intensive Outpatient or Partial Hospitalization, (c) at least one outpatient claim, or (d) at least one ED claim for treatment of a covered mental health diagnosis during the measurement period Total number of Members with at least one contact during the specified fiscal year (12-month period) Page 2 of 16

3 # Priority Type Performance Measure Core Measures (implement 9/1/09) 13 C AC Follow-up appointments within seven (7) and thirty (30) days after hospital discharge 14 C AC Percent of Members with SMI with a focal point of behavioral health care 15 C CC Improving physical healthcare access 16 C AC Inpatient Utilization (per 1000 Members) Total number of discharges with an outpatient service within 7 and 30 days (the 30 days includes the 7 day number). Total number of Members that meet at least one of the identified track criteria with the same billing provider during the measurement period (SFY). Tracks are: a)treatment/recovery Track; b) Med Management Track. Total number of Members with at least one identified preventive or ambulatory medical visit during the measurement period All discharges from a hospital episode for treatment of a covered mental health diagnosis: a) non-state hospitals, b) all hospitals Total number of discharges during the specified fiscal year (July 1 - June 30) including multiple discharges for the same individual Total number of unduplicated Members meeting identified criteria for age, enrollment, and contact Total number of unduplicated Members who had at least one BHO outpatient service claim/encounter during the measurement period. Members must be enrolled at least ten months with the same BHO during the 12-month measurement period. Total number of Members during the specified fiscal year (12-month period). Yes* Page 3 of 16

4 # Priority Type Performance Measure Core Measures (implement 9/1/09) 17 C AC Hospital Length of Stay (LOS) 18 C OE Emergency Dept. Utilization (per 1000 Members) 19 C OE MHSIP & YSSF Satisfaction Surveys 20 C OE Antidepressant Medication Management - Optimal Practitioner Contacts Total days for all hospital episodes resulting in a discharge, excluding day of discharge. Discharge day must occur within the specified fiscal year (July 1 - June 30): (a) non-state hospitals, (b) all hospitals. If date of admission and discharge are the same, number of days for the episode equals one. ED visits that do not result in an inpatient admission within 24 hrs of the day of the ED visit Number of Members discharged from a hospital episode. The discharge day must occur within the specified fiscal year (July 1 - June 30): (a) non-state hospitals, (b) all hospitals. Total number of Members during the specified fiscal year (12 month period) Calculated by HCPF Calculated by HCPF Number of Members age 18 and older who had at least 3 follow-up contacts with a practitioner during the acute treatment phase (84 days or 12 weeks) of a major depressive disorder Number of Members age 18 and older diagnosed with a new episode of major depressive disorder and treated with antidepressant medication Yes* Yes* Page 4 of 16

5 # Priority Type Performance Measure Core Measures (implement 9/1/09) 21 C OE Increasing post-partum depression (PPD) screening in primary care 22 C OE Change in Recovery and Resilience All live birth Medicaid providers who use an approved PPD screening tool A sample of 20 high volume live birth Medicaid providers per BHO who had a patient diagnosed with depression/ PPD Calculated by HCPF (CCAR) Calculated by HCPF (CCAR) Page 5 of 16

6 # Development (investigate for later in contract) Type Performance Measure 23 D OE Member use of crisis intervention services > 4 times in a 30-day period Total number of Members who use crisis intervention services > 4 times in a 30-day period Total number of Members (all crisis services). 24 D OE Percent of Members screened annually for depression in primary care setting (PHQ-2) Number of Medicaid PCPs in service area using PHQ-2 Number of Medicaid PCPs in service area 25 D AC Network Adequacy and Provider Availability a. number of single case agreements b. open panel providers a. total number of network providers b. total number of providers 26 D OE Percent of Members who fail to fill or refill prescriptions for high risk medications 27 D OE Evidence-based and promising practices: measurement of two key elements of (4) adult practices and (4) child practices annually 28 D OE Number of children with mental health problems who receive screening and services. (Health People 2010) Page 6 of 16

7 # Development (investigate for later in contract) Type Performance Measure 29 D OE Use of psychotherapy for Members with diagnosis of borderline personality disorder 30 D OE Evidence of use of a standardized, validated ADHD screening tool to aid in diagnosis 31 D OE Depression management for adolescents: for those started on medication, length of treatment and percent that were referred to a mental health provider 32 D AC Penetration Rates by Diagnosis: (a) adults years with serious mental illness, (b) adults age 18+ with recognized depression, (c) adults age 18+ with schizophrenia, (d) adults age 18+ with generalized anxiety disorder 33 D AC Penetration Rates for Members with co-occurring mental health and substance abuse diagnoses Those patients in the denominator who have received psychotherapy during the specified year. The number of Members with a DSM-IV diagnosis of BPD (DSM-IV code ) in a specified year. Page 7 of 16

8 # Development (investigate for later in contract) Type Performance Measure 34 D AC Penetration Rates for Members with substance abuse diagnosis only 35 D CM Measure of community health reported by results of the BASIS 24 Health Survey received from a statistically valid sample of Members 36 D AC Percent of Members with SPMI with a review recorded in the preceding 15 months 37 D AC Focal point of behavioral care can produce a register of people with schizophrenia, bipolar disorder and other psychoses 38 D CC Members referred for followup care for alcohol problems, drug problems, or suicide attempts after diagnosis or treatment for one of these conditions in a hospital emergency department Number of Members from the denominator with a review recorded in the preceding 15 months. The practice can produce a register of Members with schizophrenia, bipolar disorder and other psychoses. Members with schizophrenia, bipolar affective disorder and other psychoses. This measure applies to practices whose Member population includes individuals with a diagnosis of schizophrenia, bipolar disorder and other psychoses (one practice at a time). Page 8 of 16

9 # Observation Type Performance Measure 39 O CM Suicides per 1000 Members 40 O CM Suicide attempt and Enrollees age >=13 with All enrollees age >=13 years completion rates by suicide attempts or adolescent Members (grades completions ascertained using 9-12) emergency room, hospital and clinic claims data (attempts: ICD-9 codes E950-E959; completions: state suicide 41 O CM Incidence of maltreatment and maltreatment fatalities of child Members 42 O CM Percent of adolescent Members who disapprove of substance abuse 43 O CM Percent of adolescent Members who perceive great risk associated with substance abuse 44 O CM Number of Members reporting use of illicit substances in past 30 days 45 O CM Number of Members reporting binge drinking of alcoholic beverages registry-cdphe) Page 9 of 16

10 # Observation Type Performance Measure 46 O CM Percent of adult Members who exceed guidelines for low-risk drinking 47 O CM Number of Member hospital emergency department visits caused by injuries Page 10 of 16

11 # Test for feasibility Type Performance Measure 48 T OE Relapse rates following treatment for Members with anorexia nervosa or bulimia nervosa 49 T OE Percent of Members with improvement in anxiety frequency 50 T OE Frequency of care for identified diagnosis groups (based on current ICD-9 codes): Psychoses ( ); Neurotic, Personality and Non-psychotic mental disorders ( , , , ) 51 T OE Percent of Members whose results on two Patient Health Questionnaires (PHQ-9s) score less than 5 or similar testing (Hamilton Rating Scale for Depression score of 7 or less) within three to seven months after diagnosis Patients from the denominator whose frequency of anxiety (reported or observed) improved compared to a prior assessment Patients with a completed episode of care who were eligible to improve in anxiety frequency Page 11 of 16

12 # Test for feasibility Type Performance Measure 52 T CM Percent of adolescents who report that in the past 30 days they rode with a driver who had been drinking alcohol 53 T OE Percent of children (age 6-12) with an BHO ambulatory prescription dispensed for an ADHD medication that had one follow-up visit with a BHO prescribing practitioner during the 30-day initiation phase 54 T OE Percent of children who remained on an ambulatory prescribed ADHD medication for at least 210 days, percent of children (age 6-12) that, in addition to the visit in the initiation phase, had a least two additional follow-up visits with a practitioner within 270 days after the initiation phase ends Page 12 of 16

13 # Test for feasibility Type Performance Measure 55 T OE Percent of children with a diagnosed mental health condition based on the DSM- IV or the ICD-9 that received mental/behavioral health services in the past six months 56 T CC Members with a preventive or ambulatory medical office visit during the measurement period. 57 T CC Documentation in the behavioral health record that the primary care physician was notified of changes in Member s medications, living situation, or significant change in Member s health condition within 30 days of change and evidence of documentation in the physical health record of receipt 58 T CM Incidence of physical assault by current or former intimate partners Individuals form the denominator whose medical record documents receipt of a physical examination within the specified 12 month period. The total number of individuals receiving services for a primary psychiatric disorder during a specified 12 month reporting period. Page 13 of 16

14 # Test for feasibility Type Performance Measure 59 T CM Age and proportion of adolescents who remain drug and alcohol-free Page 14 of 16

15 Measure Priority Type BHO RFP Key Number Core Measures- C 22 Developmental Measures- D 16 Observational Measures- O 9 Test Measures- T 12 Total # of Measures 59 Priority Definitions C- Core D- Developmental O- Observational T- Test Type AC CC CM OE Definition Core measures are measures that will be in place from the time the contract begins. Data submission will be either quarterly, semi-annually or annually, depending on the measure. Developmental measures will be investigated for the feasibility of implementation as soon as possible. Observational measures are measures that apply to a broad population; in this case, as they apply to the general behavioral health of the population. Test measures are measures that require testing before implementation. Definition Access Coordination of Care Community Health Measures Outcomes and Effectiveness Page 15 of 16

16 Core Measure Source Number 1 HCPF/BHO Scope Document/HEDIS 2 CNS Pharmacy 3 NCQA 4 CCAR 5 CCAR 6 CCAR 7 CCAR 8 HCPF 9 HCPF 10 HCPF 11 HCPF/BHO Scope Document 12 HEDIS p. 305 (2010) 13 HCPF/BHO Scope Document 14 No Reference 15 BHO Coordination of Care PIP 16 HCPF/BHO Scope Document 17 HCPF/BHO Scope Document 18 HCPF/BHO Scope Document 19 HCPF/DBH 20 AHRQ 21 No Reference 22 CCAR Definition of Member/s Individuals eligible for Medicaid assigned to a specific BHO. Membership is calculated by the number of Member months during a 12-month period divided by 12, which gives equivalent Members or the average health plan enrollment during the 12-month reporting period. Page 16 of 16